Introduction

Access to physicians is a concern for the public, the medical profession and the government. Physicians are feeling pressured to care for an increasing number of individuals, but there is a limit to the patient load any one physician can handle. In an attempt to manage workload, some physicians screen patients using a variety of methods. These practices may be or may appear to be discriminatory.

In a limited resource environment, physicians must ensure that access to care is fair. This may entail prioritizing treatment to those most in need. This policy sets out expectations for physicians when accepting new patients so that they do so fairly and professionally.

Scope

This policy applies to all physicians any time they accept new patients for primary care.

Principles

The practice of medicine is founded on the values of compassion, service, altruism and trustworthiness.[1] These values form the basis of professionalism.

Professionalism is essential to ensuring public trust.

Professionalism should underlie all interactions between physicians and the public.

Professionalism entails ensuring that health care is fairly distributed to those most in need.

Policy

Physicians who are able to accept new patients into their practice should use a first-come, first-served approach.[2]

It is not appropriate for physicians to screen potential patients because it can compromise public trust in the profession, especially at a time when access to care is a concern. Screening may also result in discriminatory actions against potential patients.

Physicians must abide by the Ontario Human Rights Code, which prohibits discrimination on the following grounds: race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation (which includes gender identity and expression), age, marital status, family status, and disability.[3] The Human Rights Code applies to the provision of all services, including medical care. Failure to abide by the Human Rights Code may result in a proceeding before the Ontario Human Rights Tribunal. It may also result in disciplinary action before the College.[4]

Clinical Competence and Scope of Practice

While physicians should accept or refuse new patients on a first-come, first-served basis, clinical competence[5] and scope of practice[6] are permissible grounds for limiting patient entry into a practice.

Some physicians’ practices are focused on treating certain groups of individuals, such as female or geriatric patients. Where the focus is legitimately based on clinical competence and a clearly defined scope of practice, this would, in most cases, be an acceptable reason for refusing to accept a potential patient. Refusal on this basis likely would not infringe the Human Rights Code.

Decisions to accept or refuse new patients must be made in good faith. Clinical competence and scope of practice must not be used as a means of unfairly refusing patients with complex health care needs or patients who are perceived to be otherwise “difficult.”

Clinical competence and scope of practice must be communicated to all individuals who inquire about becoming new patients. This will help determine if it is appropriate for them to make an appointment.

Notwithstanding the above, it is appropriate for patients in need to receive priority access to care. Determination of need may be based on assessment by an individual physician or a program such as Health Care Connect through the Ministry of Health and Long-Term Care. When determining the priority of need for the purpose of accepting new patients, physicians are expected to act in good faith.

Appendix 1: For Patients – Finding a New Doctor

It can sometimes be difficult to find a new doctor, particularly if there is a shortage of physicians in the area where you live. If you’re trying to find a new doctor, you may wish to try the following strategies:

Health Care Connect

Health Care Connect is a Ministry of Health and Long-Term Care program which helps Ontarians without a family health care provider find one.

The program refers people without a regular family health care provider to physicians and nurse practitioners who are accepting new patients in their community. To register for the Health Care Connect program, call 1-800-445-1822.

Local Hospital(s)

Hospitals often know which physicians with privileges or on staff are accepting new patients, and may be able to provide a few contacts.

Community Health Centre(s)

Community health centres are organizations that provide primary health care and prevention programs through physicians and a variety of other health professionals. If you have a local community health centre, it may be taking new patients. Keep in mind that most community health centres only provide services to people who live within their particular community (i.e., within their “catchment area”) and/or target populations. A list of community health centres in Ontario is available on the Ontario Ministry of Health and Long-Term Care’s website at: http://www.health.gov.on.ca/english/public/contact/chc/chcloc_mn.html

Local newspapers

Some physicians, including those who are new to an area or who are beginning to establish a practice, will advertise that they are accepting new patients.

Please Note: The College's public register includes a variety of information about all Ontario physicians, such as each doctor's practice address, telephone number and qualifications. It also includes any practice restrictions and information, if there is any, about current allegations or previous findings of professional misconduct, incompetence or incapacity. To access the public register, go to the College's website at www.cpso.on.ca or contact us by telephone at (416) 967-2603 or toll-free 1-800-268-7096 ext. 603.

[5] Clinical competence is achieved by attaining the required education, knowledge, skills, judgment and experience to provide safe and effective care within a certain area of medicine.

[6] Every physician has a unique scope of practice, which is determined by the physician’s clinical competence, the patients the physicians cares for, the procedures performed, the treatments provided and the practice environment. A physician’s ability to perform competently in his or her scope of practice is determined by the physician’s knowledge, skills and judgment, which are developed through training and experience in that scope of practice. Further information about scope of practice is contained in the College’s Changing Scope of Practice policy.